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Elaborado por: José Luis Pérez García

Programa de Inglés

Facultad de Medicina, UNAM

Completa la siguiente lectura con la forma correcta del comparativo del adjetivo entre paréntesis, presta atención a los símbolos + (sólo comparativo: -er, more o el comparativo irregular), - (comparativo con less o less than), > (comparativo con –er than o more than), < (comparativo con not as… as), = (comparativo de igualdad as… as). RESPONDE CON MAYÚSCULAS. El símbolo # indica dónde debes escribir una respuesta. Nombre: ____ Some Alternative Treatments for Blood Transfusions You have a 29-year-old patient affected with secondary syphilis, a 5-year-old child with otitis media, and a 25-year-old woman with bacterial pharyngitis. What do all these patients have in common? They all have diseases which usually can (and should) be treated with some kind of penicillin. Yet, your patients have another thing in common: They all are allergic to penicillin. You know that a beta-lactam agent is the first choice for all of them. But, you cannot use it. What do you do in these cases? Do you discharge your patients with no treatment for their infections? Do you get angry at your patients and do not want to see them again for being penicillin-allergic? Do you try to cope with the situation and use alternative treatments? Alternative antibiotics, such as erythromycin or clarithromycin, for instance, instead of penicillin? There are other situations in which alternative treatments must also be used. Do you prefer to learn and try to experience with new alternatives useful in such cases or do you always stick to the traditional treatment? Learning new techniques, methods, and treatments or always recurring to the same techniques? Following there are some statements about alternatives to blood transfusions. In these cases always remember: a multidisciplinary approach is _better than_(>good) a single-approach. Imagine a patient sent to your unit for _further_(+far) management. To compensate a low hematocrit, you prescribe an inspired oxygen concentration # ___________(>high) the one he received last week; so that his blood oxygen concentration increases. His electrocardiogram shows a # _______(+bad) condition of the heart. He needs an operation; and preoperatively donated blood is ready to be used # _______(+late). Your patient states refusal of blood as a benefit # ____________(>high) life itself. A # __________(+complex) situation arises because he expects and demands alternative therapies, which are either # __________(+expensive) or # _________(+hard) to do. Such moral and ethical issues are # ___________(+challenging) and # __________(+frustrating) for you. You decide to do your best. After all, the patient shows a Durable Power of Attorney Card, which details that the patient refuses whole blood and the four basic blood components: erythrocytes, platelets, plasma, and leukocytes. In addition to that, you know that you are neither the first one nor the only one; since thousands of doctors routinely apply successfully bloodless treatments to some patients. You remember an article about a program at the University of Rome, Italy, in which 51 Jehovah’s Witnesses were given bloodless treatment for both major and minor surgery procedures; in which the morbidity and mortality rates were # __________(>low) expected. Even if a # ___________(+aggressive) management is required, the statistics are reassuring. You also decide to call other specialists if necessary. Moreover, you also remember that not all the alternative treatments are # __________(+expensive) or # ____________(>difficult) any traditional procedure. To start, you restrict or decrease blood drawing. Since, this way, the hematocrit will not diminish due to sample taking. Therefore, you order the use of pediatric-sized samples, which is # ______________(+advisable), because the amount of blood drawn is # _________(>low)

and have much # __________(>short) half-lives # ________the other agents. blood samples are taken three times a day (or even more) in these patients. dextran 40. Your patient accepts this machine because he considers that his blood never stops circulating and it is not the same as a transfusion of a stored package of blood. in some way. and the gelatins.70. according to one study. You think of hemodilution. HES 264/0. urea-bridged gelatin. and modified fluid gelatin. Moreover. # __________(+large) doses of erythropoietin (150 units/kg) produce a # __________(+substantial) rise in hematocrit in about 2 weeks. ranging from 100 units/kg to 300 units/kg.70 because they are # __________(-potent) oncotic agents and have a # __________ (+long) lasting effect. such as hydroxyethyl starch (HES) 450/0. modified fluid gelatin seems # ___________(+safe) to administer in # _________(+large) amounts (e. because even though most doctors take as a rule that a hematocrit of 10 mg/dL or # ________(+low) is an indicator for transfusion. In this case you decide not to use dextran 40. the production of erythrocytes) needed by your patient. You also know that blood viscosity is # __________(+low). trauma and cardiac patients have shown that withholding transfusions to hematocrits of 7mg/dL or even # _______(+low) is # ____________(=safe) and provokes as many complications as applying the rule of 10 mg/dL of hematocrit. Massachusetts) which makes the amount of blood loss _less dangerous_(dangerous) for the patient. at the end of his/her stay in the Intensive Care Unit due to blood sample taking. or even more.g.: Haemonetics 30 blood cell processor Braintree. cleans it and recirculates the patient’s blood again in his/her body. and microcirculatory flow is # _________(+good) with hemodilution.Elaborado por: José Luis Pérez García Programa de Inglés Facultad de Medicina. Therefore. .: 4 liters infused in less than 24 hours produced no effect on coagulation). The hospital also has a red cell salvaging device (e. which helps control bleeding and promotes a # _______(+tight) and # _____(+firm) plug (clot). you know that in the last years different studies practiced on surgical. he will lose more liquid than erythrocytes. as a possibility. because iron is used in the production of erythrocytes and hemoglobin (and erythrocytes are. the infusion of crystalloid or colloid solutions into the patient’s blood vessels. In this respect. Even though slightly # __________(+high) doses. Synthetic colloids administered in amounts # ___________(>large) 2 liters in a short period of time may produce severe coagulopathy. dextran 70. Doses of erythropoietin of 50 units/kg increase hematocrit in about 4 weeks. Nevertheless.g. you consider that your patient will need 150 units/kg of epo. are sometimes used. Since. but you are not too concerned. In case of bleeding. this gelatin has a _shorter_(>short) half-life _than_dextrans. HES 264/0. Your patient has a hematocrit of 8 mg/dL. UNAM with normal size samples. You choose dextran 70 and HES 450/0. among others. You consider the use of recombinant factor VII (rFVIIa). since they are # _____________(>potent) oncotic agents. since. bags of hemoglobin). sometimes. Since these doses of erythropoietin are recommended in patients with erythropoietin levels of less than 500 U/L. you know that iron is also needed by your patient so that his hematocrit can increase with epo. which allows a # _______(+good) perfusion. a patient may lose about 500 mL (half a liter). Anaphylactoid reactions. are # ___________(+severe) with dextrans but. are rare.43. intensive care unit.43. you decide to have both kinds of gelatins at hand. since this makes the patient’s blood contain # _________(+few) red blood cells per unit of volume. one of the side effects of colloid solutions. whereas in anemic patients with already elevated erythropoietin levels much # __________(+high) doses may be required. overall. You also consider some currently available synthetic plasma volume expanders. You estimate the amount of erythropoietin (epo) (a stimulant of erythropoiesis. since this machine recovers the blood lost by the patient during surgery.

. for instance. hence. thus preventing excessive bleeding). However. therefore. Tourniquets are used in orthopedics. which prevent blood to circulate in the limb while the patient is being operated. during surgery. such as ultrasonic scalpels and electrocautery (devices that use electricity to cut and burn at the same time. it is important to be # _________(+careful) using them. blood’s oxygen content depends on oxygen bound to hemoglobin (the # __________(+great) amount) and dissolved oxygen (the # _________(+small) amount. Aminocaproic and tranexamic acids make blood loss # __________(-important). PO2 values # _____________(>high) normal may improve oxygen carriage to the tissues in severely anemic patients. A target core temperature # _____________(>low) 37°C (30°C-32°C) reduces oxygen consumption to # __________(>little) 50% below control values. but the tourniquet is left. With a # __________(+low) body temperature. Conceivably. plasma dissolved oxygen content is # _______(+high) under these circumstances. Hemoglobin solutions bind and carry oxygen in a manner # _____________(+similar) to the way red blood cells do. In severely anemic patients. and even tourniquets to make blood loss and bleeding # ____________(+controlled) and # ____________(+limited) too. in distal to proximal direction (so that blood is drawn from the member). UNAM Some considerations about oxygen carriage are important. In order to counteract this side effect.Elaborado por: José Luis Pérez García Programa de Inglés Facultad de Medicina. which closes the vessels immediately after they are cut. erythropoietin. Nevertheless. desmopressin. the solubility of oxygen is # __________(+high). Therefore. crystalloids and rFVIIa. only 1% to 2%). Fluorocarbon emulsions carry dissolved oxygen in a manner # _____________(+similar) to the way plasma does. oxygen transport is # ___________(+far) augmented with the use of a hyperbaric chamber. because its oxygen release to the tissues is # ___________(+poor). You also have certain devices available. however. human or bovine hemoglobin. topical hemostatic agents. Actually. and synthetic emulsions. deliberate hypothermia is induced with simultaneous hemodilution so that blood viscosity is not increased. Thus. You also have antifibrinolytic medicines. the delivery of oxygen to the tissues is not # ____________(+low). especially perfluorocarbon oxygen carriers (PFOC). and its potential side effects are # _____________(+severe). namely # ______(+low). which make bleeding # _______(+easy) to control or # ____________(+manageable). Hypothermia is one example. is # _____________(>limited) that of hemoglobin invivo. which reminds you that you also have some bio-artificial oxygen carriers: hemoglobin-based oxygen carriers (HBOC). since no evidence of impaired tissue oxygen extraction has been found. in a distal to proximal direction. when it reaches a certain point. a rubber bandage is put on the limb. the amount of dissolved oxygen is # ___________(+high) (up to 25% of the oxygen content in the blood). such as fibrin glue or tissue adhesives. When the member (arm or leg) of a person is to be operated. In normal conditions. blood viscosity is # ___________(+high). colloids. the risk of oxygen toxicity is # ___________(+great) with these chambers. Measures that decrease the patient’s metabolic rate are also used because the patient consumes less oxygen. one study showed that tissue affinity for oxygen during hypothermia may become _as high as_(=high) that of hemoglobin. The oxy-hemoglobin dissociation curve during hypothermia shifts leftward. antifibrinolytics. the affinity of hemoglobin for oxygen is # ____________(+high). among others. There are also some substances to control or stop bleeding. The efficacy of human hemoglobin solutions. with a # ___________(+low) body temperature. Nevertheless. blood cell salvage machines. the bandage is removed. which prevent the destruction of clots that stop bleeding.

for which you can use cardiac output and thermodilution using a pulmonary artery catheter. doctors. and fluid and volume control. according to the patient’s circumstances. but the philosophy of medicine has never been DENY TREATMENT. UNAM You can also use techniques such as meticulous surgery and strict hemostasis during surgery. there have been. and look for # ____________(+appropriate) or # ___________(+satisfactory) options for both the patient and the doctor. with no appropriate treatment at the moment. Now. some are # ____________(>convenient) or # ____________(>useful) the others. which have proved to cause a # _________(+mild) bleeding. You prefer measuring cardiac output since thermodilution is # __________(+invasive). allergy to penicillin or other substances. The alternatives chosen apply in this case. surgeons. On the contrary. researchers. cancer. and there will always be diseases or situations (syphilis. but you realize that you must assess every single case individually.Elaborado por: José Luis Pérez García Programa de Inglés Facultad de Medicina. etc. you feel # _____________(+reassured) because you realize that managing a patient who refuses blood transfusions is not # ___________(=“impossible”) some clinicians and surgeons think. There are different techniques for measuring cardiac output. You also want to assess the perfusion of the vital organs. in addition to electrosurgery. clinicians. .). In Medicine. malnutrition. hemodilution. tuberculosis. AIDS. and all the health personnel always work on the basis of offering the patient the best treatment available at the moment. there are. there were.

cámara hiperbárica soluciones de hemoglobina emulsiones de fluorocarbonos hipotermia medicamentos antifibrinolíticos electrocauterio. etc. TÉCNICA Aumento de la concentración inspirada de oxígeno Toma de muestras de sangre de tamaño pediátrico Hemodilución Dispositivo recuperador de eritrocitos (máquina recuperadora de sangre) eritropoyetina hierro Factor de coagulación VII recombinante Almidón hidroxietilo dextranos.Elaborado por: José Luis Pérez García Programa de Inglés Facultad de Medicina. UNAM Ejercicio 2 Completa el siguiente cuadro utilizando la información de Some Alternative Treatments for Blood Transfusions. bisturí ultrasónico torniquetes MECANISMO DE ACCIÓN # ________ # ________ # ________ # ________ # ________ # ________ # ________ # ________ # ________ # ________ # ________ # ________ # ________ # ________ # ________ . gelatinas (soluciones coloidales).